Group 4 - General Pathology, logic and Cytologic Techniques

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PHILIPPINE ASSOCIATION OF SCHOOLS OF MEDICAL TECHNOLOGY AND PUBLIC HEALTH Prototype Course Syllabus

Course Title: General Pathology, Histopathologic and Cytologic Techniques

Course Description:

The course is divided into three. The first part deals with the study of the basic disease process, correlating the etiology of disease with the course of development of anatomic and clinical changes brought about by the disease. The second part is the study of the histologic techniques essential in the production of histologic slides for the diagnosis of diseases including special staining procedures and other related techniques. The third part is the study and identification of cells in the diagnosis of diseases using cytologic techniques.

Course Credit: 3 units (2 units lecture, 1 unit laboratory)

Contact Hours: 2 hours lecture, 3 hours laboratory per week (36 hours lecture and 54 hours laboratory per semester)

Prerequisites: Cytogenetics, Histology

Placement: Fourth Year, 1

st Semester

Terminal Competencies: At the end of this course, the student is able to:

1. acquire the basic concepts of disease formation. 2. explain the physiologic changes brought about by various disease processes. 3. discuss the principles and procedures in cell and tissue preparation and processing 4. develop the necessary skills required in the preparation of slides for microscopic examinations. 5. apply the concepts of quality assurance program in histopathologic laboratory. 6. discuss the principles and procedures in autopsy and biopsy 7. acquire basic concepts and skills in exfoliative cytology 8. manifest the medical technologist’s personal, social and professional responsibilities in helping restore or maintain the health of men with high moral and ethical standards.

References:

1. Allen D. and R.I. Cameron. Histopathology Specimens: Clinical, Pathological and Laboratory Aspects. USA: Springer, 2004. 2. Cibas E. and B. Ducatman. Cytology: Diagnostic Principles and Correlates 2

nd ed. Philadelphia: W.B. Saunders Co., 2003.

3. Curran R.C. and Crocker J. Curran’s Atlas of Histopathology, New York: Oxford University Press Inc., 2000. 4. Demay Richard M. The Pap Test: Exfoliative Gynecologic Cytology. Chicago: ASCP Press, 2005.

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5. Demay, Richard M. Practical Principles of Cytopathology Revised. Chicago: ASCP Press, 2007. 6. Gregorios-Bruce, Jocelyn. Histopathologic Techniques 2

nd ed. Quezon City: JMC Press, 2006.

7. Koss L. and M. Melamed. Koss’ Diagnostic Cytology and its Histopathologic Bases 5th ed. Philadelphia: Lippincott Williams and Wilkins, 2005.

8. Kumar V., N. Fausto and A. Abbas. Robbins and Cotran Pathologic Basis of Disease 7th ed. Philadelphia: W.B. Saunders Co., 2004.

9. Kumar V., N. Fausto, A. Abbas and R. Mitchell. Robbins Basic Pathology 8th ed. Philadelphia: W.B. Saunders Co., 2004.

10. Ludwig, Jurgen. Handbook of Autopsy Practice 3rd

ed. USA: Humana Press, 2002. 11. McClatchey, Kenneth. Clinical Laboratory Medicine 2

nd ed. USA: Lippincott Williams and Wilkins, 2002.

12. Mcpherson, Richard A. and Matthew R. Pincus. Henry’s Clinical Diagnosis and Management by Laboratory Methods 21st ed. Philadelphia: Elsevier Inc., 2007.

13. Ramzy, Ibrahim. Clinical Cytopathology and Aspiration Biopsy 2nd

ed. USA: Mc-Graw Hill Professional, 2000. 14. Rubin R. and D. Strayer. Rubin’s Pathology: Clinicopathologic Basis of Medicine 5

th ed. Philadelphia: Lippincott Williams and Wilkins, 2007.

15. Rutty, Guy N. Essentials of Autopsy Practice: Current Methods and Modern Trends 3rd

ed. USA: Springer, 2005. 16. Solomon, Diane and Ritu Nayar. The Bethesda System for Reporting Cervical Pathology: Definitions, Criteria and Explanatory Notes 2

nd ed. USA: Springer, 2005.

17. Stevens A, J. Lowe and B. Young. Wheater’s Basic Histopathology: A Color Atlas and Text. USA: Churchill Livingstone, 2002. 18. Tadrous, P.J. Diagnostic Criteria Handbook in Histopathology. USA: John Wiley and Sons, 2008.

Electronic References:

1. http://pathweb.uchc.edu/ 2. http://www.cytopathnet.org/tiki-index.php 3. http://www.immunoportal.com/ 4. http://www-medlib.med.utah.edu/WebPath/general.html 5. http://www-medlib.med.utah.edu/WebPath/HISTHTML/HISTOTCH/HISTOTCH.html

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T.A. Teaching Strategies Learning Objectives / Intermediate Competencies

Content

Lecture Laboratory

Skills Values Evaluation/Assessment

At the end of this unit, the student is able to:

1. Discuss the normal histology.

2. Describe normal structure of cells and tissues.

3. Define different terms associated with pathology.

4. Explain the pathophysiology of disease process.

5. Define the division and scope of pathology.

6. Enumerate the biologic causes of disease.

7. Differentiate between the structure of normal and abnormal cells and tissues.

Part I – General Pathology I. Introduction 1. Review of Normal Histology 2. Definitions 3. Branches of pathology 4. Diseases 5. Etiology 6. Pathogenesis 7. Morphologic changes and functional

derangements 8. Clinical Significance

2 hrs

Large Group Discussion Case analysis Assignments

Communication skills Problem- solving skills Technical skills Laboratory Safety Identification skills

Honesty Commitment Responsibility Accountability Adherence to rules Cooperation Teamwork Concern for others and the environment Prudence in the use of reagents & materials

Written exam Oral examination Performance checklist

At the end of this unit, the student is able to: 1. Differentiate the different types of

death. 2. Enumerate the different somatic

changes. 3. Identify microscopic tissue

findings in necrosis. 4. Explain the mechanism of the

changes in somatic change 5. Discuss the alterations involved in

specific organ/s after an injury. 6. Explain the pathophysiology of

the disease process. 7. Identify the microscopic changes

in the disease process.

II. Cellular Injury and Cell Death 1. Normal homeostasis 2. Reversible cell injury 3. Irreversible cell injury 4. Cell death 5. Apoptosis 6. Necrosis

3 hrs






1. Differentiate the type of cell adaptation due to sudden changes in the internal milieu.

2. Identify which are reversible, irreversible and precancerous lesions.

3. Explain the pathophysiology of different adaptation.

III. Cellular Adaptation

1. Terms 1.1. Atrophy 1.2. hypertrophy 1.3. Hyperplasia 1.4. Metaplasia

2. Definition, types, etiologies of different cell adaptation

3. Degeneration, pigmentation, pathologic accumulation of chemicals 3.1. Etiology

3 hrs


Communication skills Problem- solving skills Technical skills Laboratory Safety

Honesty Commitment Responsibility Accountability Adherence to rules Cooperation Teamwork Concern for others and the environment


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4. Explain the mechanisms involved in degeneration, pigmentation and hyperbilirubinemia.

5. Identify microscopic changes in the degenerative process of the disease.

3.2. Types 3.3. Pathophysiology

4. Pathologic calcification

Identification skills

Prudence in the use of reagents & materials

At the end of this unit, the student is able to: 1. Explain terms related to

inflammation and repair. 2. Discuss the importance of body

response to inflammation. 3. Identify the clinical manifestations

in the presence of inflammation. 4. Identify the causes of

inflammation and its preventive measures and possible management.

IV. Inflammation and Repair 1. Definition 2. Etiology 3. Cardinal signs 4. Classification 5. Mechanisms of acute and chronic

inflammation 6. Cells of inflammatory response 7. Tissue healing and repair

2 hrs





At the end of this unit, the student is able to: 1. Classify diseases according to

etiology 2. Identify the distinctive features of

the commonly encountered diseases

3. Correlate the laboratory findings with the etiology of disease

4. Explain pathognomonic findings in each disease.

5. Explain the pathologic events that take place during the disease process.

V. Etiology of Diseases 1. Genetic Diseases

1.1. Definition 1.2. Classification

2. Hemodynamic Disorders 2.1. Definition 2.2. Pathogenesis 2.3. Classification

3. Nutritional Diseases 3.1. Definition 3.2. Pathogenesis 3.3. Classification

4. Metabolic Diseases 4.1. Definition 4.2. Pathogenesis 4.3. Causes

5. Neoplasia 5.1. Definition 5.2. Pathogenesis 5.3. Classification 5.4. Causes

6. Infectious Diseases 6.1. Definition 6.2. Pathogenesis 6.3. Classification 6.4. Causes

7. Diseases caused environmental, chemical

12 hrs





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and physical injuries 7.1. Definition 7.2. Pathogenesis 7.3. Classification

At the end of this unit, the student is able to: 1. Discuss advantages and

disadvantages between fresh tissue examination and that of the preserved tissue examination.

2. Perform different methods of fresh tissue examination.

3. Select which method of tissue examination be performed per specific sample tissue.

4. Explain the mechanism of tissue preservatives.

5. Explain the steps involved in tissue processing.

Part II – Histopathologic Techniques I. Introduction to Tissue Processing 1. Overview 2. Methods of tissue examination

2.1. Fresh tissue 2.2. Preserved tissue

3. Receiving, custody and identification of tissues

4. Grossing and section cutting

2 hrs


Demonstration Performance of Tests Output Presentation



Written exam Oral examination Performance checklist Practical examination Return demonstration

At the end of this unit, the student is able to: 1. Identify which of the fixative will be

used for a given sample specimen.

2. Explain the significance of using specific fixative for a specific tissue specimen.

3. Discuss the importance of tissue fixation immediately after removing it from human body.

4. Discuss the characteristics of good fixative.

II. Fixation 1. Definitions 2. Characteristics of good fixatives 3. Effects of fixation 4. Methods of Fixation

4.1. Chemical 4.2. Heat 4.3. Vapor 4.4. Microwave irradiation 4.5. Ultrasound 4.6. Vacuum 4.7. Others

5. Types of Chemical fixatives 5.1. Composition and preparation 5.2. Advantages and Disadvantages

6. Factors affecting the rate of fixation 7. Secondary fixation and post-chromatization

6 hrs






At the end of this unit, the student is able to: 1. Explain the basic concept of

decalcification 2. Choose the best decalcifying

agent or method for decalcified tissue.

3. Identify the factors that may affect the process of decalcification

4. Perform the process of decalcification

III. Decalcification 1. Definition 2. Decalcifying agents

2.1. Composition and preparation 3. Methods of decalcification 4. Factors affecting the process of

decalcification 5. Ways of measuring the extent of

decalcification 6. Tissue softeners

3 hrs




Honesty Commitment Responsibility Accountability Adherence to rules Cooperation Teamwork Concern for others and the environment


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5. Discuss the other methods of tissue softening process.


Prudence in the use of reagents & materials

At the end of this unit, the student is able to: 1. Explain the significance of the

process of dehydration. 2. Identify the toxic effects of some

dehydrating agents and how to prevent toxicity.

3. Choose the best dehydrating agent for given sample tissue.

IV. Dehydration 1. Definition 2. Characteristics 3. Methods of dehydration 4. Types of dehydrating agents 5. Advantages and disadvantages

3 hrs






At the end of this unit, the student is able to: 1. Explain the significance of clearing

prior to impregnation. 2. Identify the toxic effects of some

clearing agents and how to prevent toxicity.

3. Choose the best clearing agent for a given sample tissue.

V. Clearing/Dealcoholization 1. Definition 2. Characteristics 3. Clearing agents 4. Composition and preparation 5. End-point of clearing

3 hrs






At the end of this unit, the student is able to: 1. Explain the importance of tissue

impregnation. 2. Perform the procedure of tissue

impregnation. 3. Discuss the importance of paraffin

wax impregnation. 4. Identify other infiltrating media

VI. Impregnation/Infiltration 1. Definition 2. Types of impregnation

2.1. Paraffin wax impregnation 2.1.1. Factors affecting paraffin wax

impregnation 2.1.2. Substitute 2.1.3. Precautions 2.1.4. Methods

2.2. Other infiltrating media 2.2.1. Celloidin 2.2.2. Resin 2.2.3. Gelatin 2.2.4. Others

4 hrs







VII. Embedding, Casting, Blocking or Molding. 1. Definition

2 hrs

Large Group Discussion

Demonstration

Communication skills

Honesty Commitment

Written exam Oral examination

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1. Explain the advantages and disadvantages of each type of mold.

2. Explain the importance of molding the sample tissue prior to sectioning.

3. Perform the procedure of embedding.

4. Explain the importance of trimming the tissue prior to sectioning.

2. Types 3. Orientation 4. Trimming

Case analysis Assignments

Performance of Tests Output Presentation

Problem- solving skills Technical skills Laboratory Safety Identification skills

Responsibility Accountability Adherence to rules Cooperation Teamwork Concern for others and the environment Prudence in the use of reagents & materials

Performance checklist Practical examination Return demonstration

At the end of this unit, the student is able to: 1. Identify different types of

microtome. 2. Discuss the use of each type of

microtome. 3. Explain the use of each microtome

knife. 4. Discuss the importance of honing

and stropping. 5. Implement measures to resolve

problems encountered during section cutting

6. Explain the significance of the use of adhesives

VIII. Microtome, Section Cutting and Adhesives 1. Types 2. Care 3. Techniques 4. Parts

4.1. Microtome knife 5. Honing

5.1. Types of hones 6. Stropping 7. Problems and resolutions encountered in

Section Cutting 8. Adhesives

8.1. Types 8.2. Composition and preparation

5 hrs






At the end of this unit, the student is able to: 1. Explain the ideal dye for a given

sample specimen. 2. Perform the procedure of staining. 3. Discuss the ideal special stain for

tissue 4. Discuss the appropriate

immunohistochemical and special stains for special conditions.

IX. Staining 1. Definition 2. Types 3. Composition and preparation 4. Methods 5. Immuno-stains 6. Special stains

6 hrs






At the end of this unit, the student is able to: 1. Identify different types of mounting

media. 2. Perform the proper procedure of

X. Mounting 1. Types

1.1. Aqueous 1.2. Resinous

2. Composition and preparation

2 hrs

Large Group Discussion Case analysis

Demonstration Performance of Tests

Communication skills Problem- solving skills

Honesty Commitment Responsibility Accountability Adherence to


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mounting the tissue. Assignments Output Presentation

Technical skills Laboratory Safety Identification skills

rules Cooperation Teamwork Concern for others and the environment Prudence in the use of reagents & materials

At the end of this unit, the student is able to: 1. Identify the different techniques of

labeling. 2. Explain the precautions in

labeling.

XI. Labeling 1. Techniques 2. Precautions

2 hrs






At the end of this unit, the student is able to: 1. Identify the specimens suitable

for cell blocking. 2. Explain the method of fixation for

specimens used for cell blocking 3. Explain the various procedures

and techniques in cell blocking.

XII. Cell Blocking 1. Definition 2. Specimens 3. Fixation 4. Procedures and techniques

3 hrs






At the end of this unit, the student is able to: 1. Explain the various components

of the automated tissue processor.

2. Differentiate the different types of automated tissue processing

3. Explain the advantages and disadvantages of automated tissue processing.

XIII. Automated Tissue Processing 1. Definition 2. Types 3. Advantages and Disadvantages

2 hrs



Honesty Commitment Responsibility Accountability Adherence to rules Cooperation Teamwork Concern for others and the


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environment Prudence in the use of reagents & materials

At the end of this unit, the student is able to: 1. Explain the rapid processing

techniques for tissue examination. 2. Discuss the methods of fixation

and processing of frozen sections. 3. Explain the staining technique for

frozen sections 4. Explain the significance rapid

tissue processing in laboratory diagnosis of diseases

XIV. Rapid Processing Techniques 1. Definition of terms 2. Advantages and disadvantages of frozen

sections 3. Fixation of tissues for frozen section. 4. Freezing microtome and types. 5. Staining of frozen sections

2 hrs






At the end of this unit, the student is able to: 1. Discuss the concepts of

Immunohistocytochemistry in the histopathology laboratory.

2. Explain the role of Immunohistocytochemistry in the laboratory diagnosis of diseases

3. Apply appropriate techniques of Immunohistocytochemistry in the diagnosis of various diseases.

XV. Immunohistocytochemistry 1. Definition 2. Application 3. Diagnostic interpretation

3 hrs





At the end of this unit, the student is able to: 1. Explain the methods of collection

and handling of surgical biopsy specimens.

2. Enumerate and differentiate the different types of biopsy techniques

XVI. Biopsy 1. Excision 2. Incision 3. Core-needle biopsy 4. Fine needle aspiration biopsy 5. Processing

2 hrs





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At the end of this unit, the student is able to: 1. Discuss the purpose of autopsy

(PME) 2. Discuss and differentiate the

techniques of performing autopsy. (Virchow, Rokitansky, Ghon, Letulle)

3. Enumerate the legal requirements and documents needed prior to performance of PME whether medical or medico-legal.

4. Explain the mechanism of changes seen in somatic death (post mortem changes), and discuss their relevance and importance including medico legal applications.

5. Enumerate personnel behind PME and specify their functions (pathologist, medico-legal officer, histotechnologist, histotechnicians).

6. Differentiate medical from medico-legal autopsy.

7. Discuss proper handling, techniques of gross autopsy specimen.

XVII. Post mortem examination/PME (Autopsy) 1. Signs of somatic death (Post mortem

changes) 1.1. Rigor mortis 1.2. Algor mortis 1.3. Post mortem clotting of blood 1.4. Discoloration of tissues 1.5. Putrefaction 1.6. Desiccation

2. Purpose of PME 3. Techniques of PME 4. Requirements of PME 5. Personnel involved in PME 6. Medical autopsy vs. medico-legal autopsy 7. Classification of autopsy specimens. 8. Proper handling of autopsy specimen.

3 hrs


Viewing of actual autopsy




At the end of this unit, the student is able to: 1. Explain the significance of

cytologic examination. 2. Identify the specimen processed

under exfoliative cytology. 3. Explain the significance of fixation

and adhesion in exfoliative cytology.

4. Perform the procedure for pap’s staining of samples of tissue.

5. Prepare reports in exfoliative cytology in a standard manner of reporting

6. Correlate results in exfoliative cytology with various physiologic and pathologic conditions.

Part III – Exfoliative Cytology 1. Definition 2. Importance 3. Specimens

3.1. Collection 4. Fixation 5. Staining Techniques 6. Methods of Reporting 7. Interpretation of Results (Clinical

Significance)

15 hrs






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Technical Working Group for Prototype Course Syllabi Development (2007-2008)

Zennie Aceron Petrona Benitez Sergia Cacatian Zenaida Cajucom Edwin Cancino Jacinta Cruz De Carlos Leon Oliver Shane Dumaoal Bernard Ebuen Nini Lim

Frederick Llanera Carina Magbojos Gregorio Martin Fe Martinez Josephine Milan Ferdinand Mortel Magdalena Natividad Rodolfo Rabor Ma. Teresa Rodriguez Celia Roslin

Anacleta Valdez Rowen Yolo and other PASMETH members not cited in this page who in one way or another has contributed greatly to the success of this endeavor…

Documents

Group 4 - General Pathology, logic and Cytologic Techniques